Ischemic stroke physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

A systematic review found that acute facial paresis, arm drift, or abnormal speech are the best findings.

Physical Examination

Site of Infarction	Specific area involved	Physical exam findings
		Motor strength	Reflexes	Cranial nerves involved	Sensations	Coordination	Babinski's sign	Pupils	Pupillary reflex
Cerebral cortex	Frontal lobe Perietal lobe temporal lobe Occipital lobe	++	+	++	+	+	++	+	+
Brain stem	Midbrain Pons Medulla	++	++	++	+	+	++	+	+
Cerebellum	Community-acquired, ingestion of undercooked poultry	++	+	++	+	+	++	+	+
"Central pathway involved"	Spinothalamic tract Corticospinal tract Medial leminscus	±	+	++	++	+	++	+	+

Glassgow coma score

Glassgow coma score helps determine the severity of infaction and extent of damage.

Parameter	Patient response	Glassgow coma score
Eye opening	Frontal lobe Temporal Parietal Occipital	A B C
Motor response	Midbrain Pons Medulla	A B C
Verbal response	A B C D	A B C D

Appearance

The patient may appear confused.

Eye

• Vision problems may be present.
• Drooping of eyelid (ptosis) and weakness of ocular muscles

Ear

• Altered hearing may be present.

Extremities

• Arm drift
• Weakness

Neurologic

• Abnormal speech
• Acute facial paresis
• Decreased reflexes: gag, swallow, pupil reactivity to light
• Disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe)
• Hemineglect (involvement of parietal lobe)
• Loss of co-ordination
• Memory deficits (involvement of temporal lobe)
• Numbness
• Reduction in sensory or vibratory sensation